US 20080139888 A1
A tip element for an otoscopic apparatus includes engagement features that permit selective attachment to two different tip attachment mechanisms. The tip element includes both interior and exterior engagement features that provide interchangeability with otoscopes having different tip attachment schemes. The tip element includes an increased distal aperture formed from a decreased slope that enables a larger field of view, permitting the entire tympanic membrane to be viewed at once. External engagement features permit ejection of the tip from the otoscope, as well as stackability of a plurality of tip elements.
1. An otoscopic instrument comprising:
an instrument head; and
a tip attachment mechanism disposed on said instrument head for receiving and retaining a tip element, said tip attachment mechanism including rotatable actuable means for ejecting a said tip element from said instrument, said tip attachment mechanism including at least one circumferentially disposed securing slot sized for receiving a corresponding external engagement feature of said tip element.
2. An instrument as recited in
3. An instrument as recited in
4. An instrument as recited in
5. An instrument as recited in
6. An instrument as recited in
7. An instrument as recited in
8. An instrument as recited in
9. A tip element for securing to an otoscope, said tip element comprising:
an internally open proximal portion and an internally open distal portion, said internally open distal portion having a distal end and an inner surface symmetric about an axis, said inner surface having a diameter that increases monotonically with distance proximally from said distal end;
an inner diameter of said distal end being greater than 2.6 mm;
a diameter of said inner surface equal to 7.0 mm at a distance greater than 18 mm proximal from said distal end; and
an increase less than 6.2 mm in the length of a stack of said tip elements produced by adding one said tip element to said stack of said tip elements.
10. A tip element as recited in Clam 9, wherein said tip element has a wall thickness of about 0.04 mm.
11. A tip element as recited in
12. A tip element as recited in
13. A seal assembly for attachment to a speculum tip element, said seal assembly including an elastomeric body having an opening sized to receive the exterior of a tip element having a substantially axisymmetric body, said tip element including an open distal end and an open proximal end, such that said body is mounted to the exterior of said tip element, said body being shaped to provide a substantially fluid-tight seal when engaged with the ear canal of a patient to permit insufflation using an otoscopic instrument.
14. A seal assembly as recited in
15. A seal assembly as recited in
This patent application is a divisional application of U.S. Ser. No. 10/897,455, filed Jul. 23, 2004, which claims priority under 35 USC §119(e) based upon the following commonly owned provisional patent applications: U.S. Ser. No. 60/543,858, filed Feb. 11, 2004, U.S. Ser. No. 60/507,543, filed Sep. 30, 2003 and U.S. Ser. No. 60/490,566, filed Jul. 28, 2003, the entire contents of each being herein incorporated by reference.
This invention relates generally to the field of otoscopy and in particular to an improved otoscopic instrument and at least one improved releasably attachable tip element for use with otoscopic apparatus.
Otoscopes are hand-held instruments that are commonly known in the medical diagnostic instrument field by practitioners and health care providers primarily for examining the ear, including the tympanic membrane, of a patient.
A typical otoscope is capable of being held in the hand of a practitioner and includes an instrument head having a distal frusto-conical insertion portion that permits overlying attachment of a disposable speculum tip. The disposable speculum tip is also preferably designed with a fusto-conical configuration to permit insertion to only an appropriate distance into the ear canal of the patient. Commonly, a ringlet of optical fibers encircles the tip opening of the insertion portion so as not impede with the user's visualization of the target, the fibers extending from a contained light source, such as a miniature incandescent lamp or bulb, that is housed within the instrument handle or a neck portion of the instrument head. The target (e.g., the tympanic membrane) is then viewed via a lens located in the proximal end of the instrument head, the lens being aligned optically with the distal tip opening of the insertion portion to permit user viewing. Often, the lens magnifies the view of the target.
Alternatively, a video camera or at least one solid state imaging element, such as a CCD- or CMOS-based imager, can be used to view the target in lieu of the lens, the image as processed being transmitted to a video monitor for display. In addition, the instrument head can include a receiving port for a pneumatic bulb, permitting insufflation (e.g., pneumatic otoscopy). These devices can also be used, in some instances, for examining the nose and throat in addition to the ear and ear canal, as well as to provide a general illumination and magnification system.
There are a number of perceived needs in the field currently. When considering the basic functions of the otoscope; e.g., visualization of the tympanic membrane, there have been expressed needs to increase the field of view and to provide greater magnification thereof, in addition to eye relief. Eye relief is practically defined as the distance between the most proximal optic of the instrument (e.g. the optic closest to the practitioner's eye) and the practitioner/user's eye when the full field is viewed. Magnification and eye relief are interrelated such that having an image overly magnified will bring the image “closer” to the eye of the practitioner, etc. Current otoscopes, due to the tortuous construction of the ear canal and the lenses that are used therein, cannot fit the entire tympanic membrane into the field of view.
To provide all of these noted improvements, in general, requires a tradeoff in depth of field, since optically all of the above factors are related. For example, the consequence of a depth of field loss is that for some patients with either long or short ear canals (as compared to a so-called “standard” or nominal ear canal), the tympanic membrane would no longer be in focus. This lack of focus is a distinct disadvantage and would seriously impact the practitioner's ability to give proper care.
There is yet another need generally in the field to be able to perform different diagnostic procedures as part of a comprehensive otoscopic examination. This need places increasing demands and constraints upon releasably attached disposable speculum tips used with the apparatus, in order to maintain cleanliness and prevent cross-contamination. A brief list of the requirements that are attributed to these type of otoscope tips include the following:
i) to achieve the “best view” (e.g., straighten the ear canal walls, maximize clear aperture);
ii) to effectively transmit light to the tympanic membrane and to collect light transmitted back from the tympanic membrane in order to effectively permit viewing thereof;
iii) to provide an effective substantially fluid-tight seal with the ear as well as with the instrument head in order to permit insufflation (e.g., pneumatic otoscopy);
iv) to allow placement and use of certain instrumentation while viewing through the optics, for cerumen (ear wax) removal.
v) to permit stacking of the tips in a compact fashion to facilitate storage in a dispenser or work kit;
vi) to be adequately cost-effective terms of manufacture in order to permit the tips to be disposable or replaceable;
vii) to prevent cross contamination;
viii) to fit a variety of patients (e.g., different sizes)
ix) to minimize the risk of unsafe insertion into the typical ear; and;
x) to fit relevant otoscopes used.
To meet this fairly comprehensive list of requirements, it becomes clear that any presently known otoscope tip would either optimize for only one or two of the above attributes, or perform moderately on a few of them. As a result, there are shortcomings, particularly with regard to disposable speculum tip designs that are presently available.
It is therefore one primary object of the present invention to provide an otoscopic apparatus that alleviates the above-noted problems and deficiencies of the prior art.
It is another primary object of the present invention to provide at least one or a family of otoscopic tips that provide optimum solutions for the above-noted requirements, with the fewest number of otoscope tips. This objective is especially important in that space in a physician/practitioner's office can be an issue, as well as the logistics and other issues that are often associated with managing various multiple tips.
Therefore and according to a first preferred aspect of the present invention, there is provided a tip element for securing to an otoscope, said tip element including a substantially axisymmetric body having a distal open end and a proximal open end, the tip element having at least one external engagement feature extending radially from the proximal end, the at least one external engagement feature being adapted for engaging a tip attachment mechanism of an otoscope. The at least one external engagement feature of the herein described tip element preferably is defined by a circumferential securing portion that is sized to fit within a securing slot of a tip attachment mechanism of an otoscope when the tip element is twisted thereupon in a first predetermined direction.
Preferably, the at least one external engagement feature further includes at least one axial portion depending from the circumferential securing portion, the at least one axial portion extending axially in a direction toward the distal open end of the tip element. In a preferred version, three (3) external engagement features, as described above, are provided, though this number can be suitably varied. A plurality of axial gripping ribs can also be provided on the exterior of the tip element, some or all of these ribs including the axial portions of the external engagement features.
According to another aspect of the invention, angled tabs, ribs or wedges are disposed about the periphery of the proximal end of the tip. Preferably, at least one of the engagement features of the tip element and the otoscope include sawtooth like “steps” in order to provide tactile feedback for the user when attached to the instrument head and to improve the engagement and sealed connection therebetween.
The otoscopic tip element can further include at least one interior engagement feature as well, for permitting attachment of the otoscopic tip element to an attachment portion of another type of otoscope, thereby permitting the tip element to be used more or less universally or interchangeably with various types of tip attachment mechanisms as provided on different otoscopes. The interior surface of the tip element is preferably polished in order to improve light transmissibility and further includes an interior sealing feature, such as an annular sealing ring, that permits or aids in the sealing of the tip element relative to the otoscope for insufflation purposes.
According to still another preferred aspect of the present invention, there is provided a tip element for an otoscope, the tip element comprising a substantially axisymmetric body having an open distal end and an open proximal end, and means for adaptively engaging with an instrument head of an otoscope, wherein the adaptive engaging means permits interchangeable attachment of the tip element to at least two different tip attachment mechanisms.
The adaptive engaging means preferably includes first engaging means for engaging an otoscope with a first tip attachment mechanism and second engaging means for engaging an otoscope with a second tip attachment mechanism. According to one version thereof, the first engaging means includes at least one external engagement feature and the second engaging means includes at least one internal engagement feature.
The at least one external engagement feature is provided radially relative to the body of the tip element and includes at least one circumferential securing portion sized for engaging a securing slot formed on an attachment portion of the instrument head. The at least one interior engagement feature includes at least one protrusion sized for engaging a bayonet-like slot in an attachment portion of an instrument head.
Preferably, the securing slots and the circumferential securing portions are substantially wedge-shaped, wherein the tip element is twisted in a first predetermined direction in order to engage the at least one circumferential securing portion with the at least one securing slot of the instrument head. According to a preferred version, a set of teeth are provided on an engagement surface of at least one of the securing slot and circumferential securing portion.
A plurality of tip elements can be provided in which the tip elements can be color-coded based on the type of patient used (size of the tip) and/or intended use thereof.
The tip elements as described are preferably disposable and to that end are fabricated such that their geometry permits stacking. At least one axial portion, depending from the at least one circumferential securing portion, assists in the stackability of a plurality of tip elements as well as provides a gripping surface to aid in attaching and removing the tip from the otoscope. In addition and according to a preferred version, a plurality of axial ribs additionally provided on the exterior of the tip element further provide means for gripping, as needed.
According to yet another aspect of the invention, there is provided an otoscopic assembly including at least one otoscopic instrument having an instrument head that includes at least one tip attachment mechanism; and a releasably attachable tip element in which the tip element includes a substantially axisymmetric body having an open distal end and an open proximal end and means for adaptively engaging the tip element with the instrument head, wherein the adaptive engaging means permits interchangeable attachment of the tip element to at least two different tip attachment mechanisms.
The otoscopic instrument includes an optical system contained therein that when aligned with an attached tip element permits the entire tympanic membrane to be viewed without panning of the instrument.
Additionally, an instrumentation tip element can be attached to the otoscopic instrument in lieu of the tip element previously described, the instrumentation tip element having an open-framed structure that defines openings that permit the insertion of at least one surgical instrument, such as a curved curette. The structure of the instrumentation tip permits instrument insertion without significantly interfering with the viewing of a target by the user.
Alternatively, an elastomeric seal assembly is further provided according to another embodiment which permits a substantially fluid-tight seal to be formed when the assembly is attached onto the exterior of a tip element. In addition, the assembly is shaped to permit the assembly to be selectively moved along the length of the tip element to optimize the seal.
According to yet another preferred aspect of the present invention, there is provided an otoscopic instrument comprising an instrument head including a distal insertion portion, the distal insertion portion being sized for receiving a substantially axisymmetric tip element and a tip attachment mechanism disposed on the instrument head having attachment features for receiving an retaining a tip element, the tip attachment mechanism including rotatable actuable means for selectively ejecting a tip element from the instrument.
The tip attachment mechanism preferably includes at least one circumferentially disposed securing slot on a distal facing surface of the instrument head that is sized for receiving a corresponding securing portion of a tip element. The rotatable actuable means includes an actuator knob that includes at least one pin element for displacing the tip element from the securing slots upon rotation of the knob in a predetermined direction. The rotatable actuable means is preferably biased so as to return the pin element to a home position, the means further including at least one indicator to indicate the predetermined direction to the user.
According to yet another preferred aspect of the present invention, there is disclosed a method for manufacturing a substantially axisymmetric speculum tip element for an otoscopic apparatus, the method including the steps of: providing at least one external engagement feature on the tip element permitting the tip element to be releasably attachable to an otoscopic instrument via a first tip attachment mechanism, the at least one external engagement feature extending radially from the proximal end of the tip element and manufacturing the tip element by means of a molding process.
According to still another preferred aspect of the present invention, there is disclosed a tip element for securing to an otoscope, said tip element comprising an internally open proximal portion and an internally open distal portion, said internally open distal portion having a distal end and an inner surface symmetric about an axis, said inner surface having a diameter that increases monotonically with distance proximally from said distal end; an inner diameter of said distal end being greater than 2.6 mm; a diameter of said inner surface equal to 7.0 mm at a distance greater than 18 mm proximal from said distal end; and an increase less than 6.2 mm in the length of a stack of said tip elements produced by adding one said tip element to said stack of said tip elements.
One advantage of the present invention is that a practitioner can use the herein described instrument without additional training being required.
An additional advantage of the present invention is that the improved tip design permits fewer tip sizes to be used while permitting enhanced otological examinations to be conducted.
The addition, by permitting use of a universal tip with both multiple existing otoscopes as well as the herein described otoscopic instrument design allows the practitioner having both prior art otoscopes as well as with the herein described otoscope to not have to keep track of the tips being used and permits the doctor or other practitioner to retain both types of otoscopes.
The addition of external bayonet-like engagement features on the tip elements creates a “grip” area that enables users to place the tips onto the existing otoscope more securely than is otherwise presently achievable. In addition, the improved draft angle and polished interior improve the efficiency of light transmission both into and out from the tip element.
Yet another advantage of the present invention is the non-contact releasability of the tip element from the otoscope.
These and other objects, features and advantages will become readily apparent from the following Detailed Description which should be read in conjunction with the accompanying drawings.
The following description relates to a preferred embodiment of an otoscope that is made in accordance with the present invention as well as to preferred embodiments of a disposable, releasably attachable otoscopic tip element design. However, from the description there are many variations and modifications that will become apparent to one of sufficient skill in the field that can be made in accordance with the following inventive aspects.
In addition, several terms such as “distal”, “proximal”, “top”, “bottom”, “front”, “rear”, clockwise”, “counterclockwise”, and others are used throughout the discussion in order to provide a convenient frame of reference with regard to the accompanying drawings. These terms, however, should not be necessarily be regarded as limiting, except where so specifically indicated.
Before referring more specifically to a more detailed description of the remainder of the herein described otoscopic instrument 10, the following discussion refers to
For purposes of the following discussion, the tip element 40 shown in
In addition to the above, the present tip elements 40 each include a larger distal aperture and can comfortably extend a greater distance into the ear canal of a patient than any previously known disposable tip element of its aperture size.
Referring back to
The interior surface 60 of the herein described tip element 40 is polished to improve light transmissibility and further preferably includes an angled interior protrusion 64 that is located near the proximal tip opening 44. Referring to
Referring now to
The above instrument 10 can be used for pneumatic otoscopy as is known through a hose connection 272,
Within the confines of the instrument head 18, and beginning at the distal axisymmetric insertion portion 29 and extending proximally therefrom along a defined optical axis 27 is an imaging train that includes a predetermined number of optical elements, most of which are disposed within an open-ended tubular member 80. The tubular member 80 has a variable diameter that is defined herein by three axial sections, each axial section having a different interior diameter. The first axial section 84 of the tubular member 80 is defined by an initial diameter at the distal end thereof, and is sized for retaining an objective distal or front lens 96 and a lens 100, respectively, each of these lenses being disposed in adjacent relation to one another to form a doublet. The lenses 96 and 100 are mounted adjacently to one another, with the objective distal lens 96 partially extending outwardly from the distal most opening of the tubular member 80. The second axial section 88 of the tubular member 80 is defined, according to this embodiment, by a second interior diameter that is larger than the diameter of the first axial section 84, the second section linking an adjacent third section 92 that contains a first relay lens 104, an aperture stop 108, and a second relay lens 112, respectively, each of these elements being appropriately spaced from one another. The diameter of the third axial section 92 of the tubular member 80 is larger than either of the diameters of the first and second portions 84, 88 thereof. A functional discussion of the imaging train as well as that of the overall optical system of the herein described embodiment 10 is provided in a later portion herein.
Referring back to the overall assembly of the instrument 10, the tubular member 80 is retained within an inner former assembly 116 that is also positioned within the instrument head 18, wherein the first axial portion 84 of the tubular member 80 is sized to fit within the distal axisymmetric insertion portion 29. The inner former assembly 116 provides support for the tubular member 80 and further provides means for a plurality of extending optical fibers (not shown) from an illumination assembly 124. Referring to
Preferably, the first axial portion 84 of the tubular member 80 is fitted within the interior of the distal axisymmetric insertion portion 29 such that the distal objective lens 96 is proximate the distal opening thereof, as shown in
An eyepiece mechanism 160, as more specifically shown in
For purposes of adjustability, the instrument head 18 further includes a pair of windows 21,
The tip actuator mechanism of the instrument 10 is now explained in greater detail with reference to
In operation, an otoscopic tip element 40 as described above, is attached onto the distal end of the instrument head 18 and more specifically in overlaying relation to the distal axisymmetric insertion portion 29, the circumferential securing portions 55 of each of the external engagement features 52 being fitted into the circumferential slots 242 that are provided in the tip element retainer member 240. The tip element 40 is then twisted, in this example, in a clockwise fashion, so as to engage the teeth 56 of two of the wedge-like engagement features 52 with the corresponding ramped surfaces 244 of the tip element retainer member 240, thereby providing positive engagement and providing tactile feedback to the user when attaching the tip element 40 to the instrument 10.
The design of the herein described tip element 40 is fairly universal; that is, the tip element is designed not only to fit the herein described instrument 10, but a number of already existing otoscopes, such as those employing bayonet-type attachment scheme as described by U.S. Pat. No. 3,698,387, and ejector-type mechanism as described be U.S. Pat. No. 4,366,811 the entire contents of each herein being incorporated by reference.
In operation, the use of the focusing mechanism permits relative movement of the optics of the eyepiece mechanism 160 relative to the imaging train of the instrument 10. The focusing sleeve member 200 and the soft grippable elastomeric cover piece 202 are each permitted to rotate about the optical axis 27, while the lens carrier member 164 and attached lens retainer member 176 are caused only to translate linearly due to the rotationally fixed connection with the instrument head 18. The remainder of the optical imaging train, disposed within the tubular member 80, including front objective lens 96 is stationary, and therefore relative movement is achieved, permitting focus adjustment to take place. As noted, the biased engagement of the ball by the compression spring into the depression of the focusing sleeve member 200 provides an indication of a predetermined fixed focus position (a preset position or distance between the eyepiece optics and the optics of the remainder of the stationary imaging train within tubular member 80) as sensed by the user/practitioner.
Indication of this preset or other focus position can be achieved by means of a visual indicator 209, provided on the exterior of the grippable elastomeric cover 202, portions of the cover being accessible through the windows 21 formed on lateral sides of the instrument head 18 to enable selective rotary movement of the focusing mechanism by mean of the soft grippable cover 202 in lieu of the focusing knob 208.
A scale of markers 213 are formed on edge portions of the instrument head adjacent the windows 21 including a preset focus position marker 215 that can be aligned with the visual indicator 209 which, in combination with the detent, further indicates the preferred nominal focusing position of the instrument 10.
In the predetermined fixed focus position, according to this embodiment, the overall length of the entire imaging system (e.g., the distance between the most distal and proximal optical surfaces including the eyepiece optics) is approximately 77.60 mm, the magnification is 1.63× when the tympanic membrane is located at a working distance of approximately 10 mm from the open distal end 44 of the speculum tip element 40, and the depth of field is approximately 3-5 mm. Additionally, the nominal eye relief is approximately 21.5 mm.
The exit pupil 9 is located approximately 21.5 mm proximal to the most proximal optical surface of lens 194. This distance provides: a) optimal image stability in relation to lateral movement of the user's eye during an ear examination; b) optimal viewing of the tympanic membrane 6 with minimal ray obstruction; and c) the ability to accommodate a large range of spectacle lenses. This exit pupil location relative to lenses 190 and 194 is constant regardless of the position of the focusing mechanism.
The optical system described herein can easily be expanded to video/imager human otoscopy by adding an electronic imager assembly 304 onto the proximal end of the otoscope, as shown in
Selective focusing travel of the lenses 190 and 194 of the eyepiece mechanism is such as to give the user the ability to achieve a close-up view (important in infant ear examinations) and a distant view (important in throat and nasal examinations). The working distance between the tympanic membrane 6 and the first optical surface of the distal lens 96 is optimized according to this embodiment to fall around 27 mm; this latter dimension is clinically important because it provides the correct setup between inserting the otoscope too deeply into the ear canal. In addition, the herein described optical system produces an erect image of the tympanic membrane to the user at the viewing means.
The imaging train substantially places the objective doublet 96, 100 within the ear at the time of examination, since this optical element is located in the distalmost L portion of the instrument head 18, and much closer to the tympanic membrane than any typical otoscope. As a result, a greater (e.g., wider) field of view is achieved, i.e., an area larger than that of the tympanic membrane can be viewed by the user in an operative position of the instrument. Moreover, the entrance pupil location enables an unobstructed view of a typical 7 mm adult tympanic membrane for working distances greater than or about 27 mm, wherein the working distance is defined as the spacing separating the tympanic membrane from the distal surface of the lens 96 or approximately, according to this embodiment, about 9.5 mm from the tympanic membrane to the distal end of the tip element 40. By creating a field of view greater than about 9 mm at a working distance of about 33 mm using the herein described optical system, the entire tympanic membrane can be observed without panning of the instrument 10. The separation between the optics contained within the tubular member 80 and the eyepiece optics 190, 194 is variable in order to permit focusing in a suitable range of working distances and compensating for user's accommodation. As a result of the foregoing, an appropriate tradeoff is achieved between magnification, field of view, working distance, eye relief and focusing range. The latter parameter is additionally critical so as to allow the instrument to be further used, for example, for examinations of the throat and/or nose of the patient.
An additional problem associated with otoscopes, particularly imaging styles with optics located in the main line of sight, is that inserting instruments into the ear is very difficult to do while seeing through the optics. Diagnostic otoscopes and others enable a magnifying window to slide to the side or out of the way, but the resulting view is typically extremely compromised and the use of a curette through the constrained area is far from ideal.
To deal with the above stated problem, an elastomeric seal accessory 300 is provided according to one embodiment that slides onto the exterior of a disposable tip element, such as those previously described in
Additional features, such as markings on the tip and depth setting provide advantages. The geometry of the elastomeric seal accessory 300 itself also creates an advantage since it is mushroom shaped in the present embodiment, allowing the accessory to collapse in order to seal with a variety of ear canal sizes. An additional advantage exists in the case of the present mushroom-shaped design in that these tips are less sensitive to positional variation (i.e., the accessory can be sealed at many different positions along the tip). Therefore, the axial position of the accessory 300 can easily be varied along the length of the tip in order to effectively optimize the seal. It should be readily apparent that there are alternative geometries that could be conceived for the elastomeric seal accessory, embodying the inventive concepts employed herein.
It should be readily apparent that other variations and modifications will be readily apparent to those of ordinary skill in the field. For example, the otoscopic instrument described herein could include tip attachment mechanisms for receiving either engagement feature of the herein described tip element. Other variations embodying the scope of the invention could easily be imagined, as defined in the following claims: